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General NPI Number Information
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NPI Number | 1467310334
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Entity Type | Individual
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Provider Name | MICHAEL KHAIMOV PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 11247 QUEENS BLVD STE 206
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City | FOREST HILLS
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State | NY
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Zip | 11375-7421
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Country | US
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Telephone | 800-200-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 9810 64TH AVE APT 5F
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City | REGO PARK
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State | NY
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Zip | 11374-2502
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Country | US
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Telephone | 718-576-5110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 03498301
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License Number State | NY
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